ACUTE MANIA: AN UNUSUAL PRESENTATION OF SMALL CELL LUNG CANCER

Abstract

TYPE: Case Report Publication TOPIC: Lung Cancer INTRODUCTION: We report a patient presenting with acute mania, and without symptoms typically associated with pulmonary malignancy, who was diagnosed with small cell lung cancer (SCLC). CASE PRESENTATION: Ms. D is a 63-year-old female with a past medical history of mild anxiety and tobacco use who was brought into the emergency department after exhibiting one month of bizarre and impulsive behavior. She never behaved like this before. Her only medication is alprazolam 0.5 mg as needed for anxiety. On presentation, her exam was notable for prominent flight of ideas, loose associations, affective lability, and pressured speech. Her sodium was 130 mmol/L, urine osmolality was 505 mOsm/kg, and urine sodium of 102 mmol/L. Urine drug screen was positive for benzodiazepines. She was given additional benzodiazepines without change in her behavior. Non-contrast computed tomography of the chest revealed a large right upper lobe nodule, bilateral mediastinal and right hilar adenopathy, and bilateral supraclavicular adenopathy. Biopsy of the supraclavicular lymph node showed SCLC. Brain magnetic resonance imaging (MRI) and lumbar puncture were unrevealing. She was discharged with follow-up with oncology and neurology, but lost to follow-up. DISCUSSION: Most patients with mania typically present before early adulthood, but for the 10% who develop mania later in life, alternative causes of mania should be considered. These include cerebral organic disorders, malignancy, and medication-induced side effects. Our patient’s mania was deemed to be of paraneoplastic etiology, possibly exacerbated by benzodiazepine use and SIADH. CONCLUSIONS: Our case underscores the importance of considering carefully all etiologies for elderly patients with new onset mania. DISCLOSURE: No significant relationships. KEYWORDS: Mania, Small cell lung cancer